Modulation of immunologic responses in nontuberculous mycobacterial infections with indomethacin

Disseminated Mycobacterium avium-intracellulare infection in a patient with myelodysplastic syndrome (refractory anemia)

A 31-year-old woman presented with fever and arthralgia. Despite treatment with antimicrobials and corticosteroids, her symptoms persisted. A diagnosis of myelodysplastic syndrome (MDS)-refractory anemia (RA) was made by pancytopenia, dysplasia, and trisomy 8. Cultures of bone marrow, blood, and gastric juice showed Mycobacterium avium-intracellulare (MAI). She was treated with antimycobacterial drugs and recombinant human G-CSF/M-CSF and showed an initial response, but spike fever recurred and pancytopenia progressed. Hepatosplenomegaly and marked retroperitoneal lymphadenopathy were revealed, indicating further dissemination of MAI. Treatment with recombinant human GM-CSF and very-low-dose cytosine arabinoside, was started but was not effective. This case showed significant reduction in peripheral blood T-lymphocytes, especially the CD4+ population, and low immunoglobulin levels. Immunodeficiency state associated with long-term steroid therapy and MDS seemed to contribute to the development of the disseminated infection with MAI.

Indomethacin-sensitive monocyte killing defect in a child with disseminated atypical mycobacterial disease

A child with disseminated disease due to Mycobacterium avium had progressive disease in spite of 4.5 years of therapy with multiple antimicrobial agents selected on the basis of in vitro sensitivity testing of her organism. A defect in monocyte bactericidal activity was detected which was corrected in vitro by exposure of the patient's monocytes to indomethacin and normal serum. Indomethacin therapy resulted in normalization of monocyte bactericidal activity and striking, albeit temporary, clinical improvement.

Rosacea-like lesions due to familial Mycobacterium avium-intracellulare infection

Mycobacterium avium-intracellulare (MAI) is a non-tuberculous, nonlepromatous or "atypical" mycobacterium now seen frequently in patients with acquired immunodeficiency syndrome (AIDS). In the past decade, the incidence appears to have increased in non-AIDS patients. Although cutaneous involvement is rare, two brothers without detectable immune defects who both presented with cutaneous MAI infection are described; the older brother also has disseminated disease. The cutaneous presentation of MAI, as well as immune and genetic defects that may predispose to mycobacterial infection, are discussed.

Prospective study of mycobacterial infections in patients with cystic fibrosis

Fifty four patients with cystic fibrosis, aged 3-67 years, were studied prospectively for pulmonary mycobacterial infection. Sputum smears and cultures were carried out and intradermal skin tests performed. Mycobacteria were cultured from six patients in association with clinical deterioration; four patients had positive direct smears. Mycobacterium tuberculosis, M aviumintracellulare, M kansasii, and M gordonae were isolated. There were no deaths and all improved with chemotherapy. A third of the other 48 patients had positive skin test responses (greater than 6 mm) to purified protein derivative (PPD) tuberculin and 21 to one or more antigens prepared from non-tuberculous mycobacteria. Sensitisation increased with age; before the age of 11 only one patient had a positive response to PPD tuberculin and none to any other antigen. This was less than in healthy control subjects of similar age. After age 11 the reactions in sensitised patients were stronger than in positive healthy control subjects. Our study indicates that it is important to consider mycobacterial infection in patients with cystic fibrosis who deteriorate without obvious cause.

Mycobacterium avium-intracellulare complex infections in the acquired immunodeficiency syndrome

This review examines an important bacterial infection in acquired immunodeficiency syndrome (AIDS). Despite occasional infections with bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, Salmonella, and Nocardia in patients with AIDS, the primary problems of AIDS and invading bacterial infections center around mycobacteriosis. A unique feature of AIDS has been the common identification of disseminated infections with Mycobacterium avium-intracellulare. The following discussion examines our present understanding of this group of organisms and how they interact with the compromised host.

The combined effect of prostaglandin E2 and interleukin 1 on interleukin 2 production and lymphocyte proliferation

In this study the combined effect of prostaglandin E2 (PGE2) and interleukin-1 (IL-1) on the proliferation of concanavalin A (Con A) stimulated mouse spleen lymphocytes was studied. IL-1 in concentrations ranging from 0.5 to 5.0 U/ml consistently and significantly enhanced Con A activity. However, to be effective, IL-1 needed to be added at the time of initiation of the culture. If added 24 h later, IL-1 failed to enhance the proliferative response. PGE2 at concentrations ranging from 0.1 to 5.0 ng/ml effectively inhibited or antagonized this enhancing effect of IL-1, with the majority of this IL-1 augmentation abrogated by 5.0 ng/ml PGE2. Unlike IL-1, PGE2 was as effective if added 24 h after initiation of the culture as if added simultaneously with IL-1. PGE2 was also found to markedly suppress the enhanced production of IL-2 resulting from the addition of IL-1 to Con A stimulated lymphocytes, however, the amount of IL-2 produced in the cultures containing both IL-1 and PGE2 was always greater than that produced in the cultures which contained only PGE2. This finding indicates that IL-1 could partially reverse or antagonize the suppressive effect of PGE2 on IL-2 production. In addition, PGE2 at concentrations of 1.0 and 5.0 ng/ml was also found to inhibit the proliferation of IL-2 stimulated cultured T lymphocytes, but by only about 15-20%. The addition of IL-1 to these cultured T cells neither altered the response of the culture T cells to IL-2 nor altered the sensitivity of these cells to PGE2.(ABSTRACT TRUNCATED AT 250 WORDS)